Thank you for tuning into the Becker's Healthcare Podcast. I am Molly Gamble,
vice President Editorial, and today I'm catching up with Dr. William Maurice.
Dr. Maurice is president of the Mayo Clinic Laboratories.
He has been with the Mayo System for 23 years,
including roles as Professor of laboratory Medicine and pathology with Mayo
Clinic School of Medicine and Division Chair of Laboratory Medicine and
Pathology. Dr. Maurice, thank you so much for joining me today.
How are you and where do we find you?
Um, uh, thank you for having me on number one. I, it's,
it's a great pleasure to join you. Uh, I'm doing well. Uh,
I've actually been at Mayo for, for longer than I've been here since 87.
I've lost counted the actual years cause I came here for medical school and
graduate school and, and never left. So I've been here for a long time.
And that's where you find me today is in Rochester, Minnesota.
Great. Well you took an opportunity that could have made you younger and,
and you correct me, which I appreciate. I had my facts wrong there, Dr. Marie.
So you've been there 87. That's says old as I am actually. So . Um,
really, really impressive longevity.
Yeah, it's the cold weather. It keeps you cryopreserved, so that's good.
Well, let's talk a little bit about the lab. You know,
I thought we could start there.
The lab has always been so important to diagnostics and care delivery,
but it seems like Covid 19 really threw labs into the center stage as
everyone and their brother just gained at least a bit more familiarity with
diagnostics and lab testing. My, you know,
hearing my 95 year old grandmother talk about p c r tests, for instance. Um,
how did renewed reliance on labs throughout the pandemic come home to
affect your work?
Well, um, I think that the, the visibility, obviously,
as you mentioned right away, uh, it's a part of healthcare. Uh,
even most people that choose laboratory medicine pathology as a medical career
often do so after they've done other areas of practice. For myself,
I did internal medicine first, um, just because it's not, so even within the,
within the practice of medicine, it's not so obvious of the career choice.
So that immediate visibility, um, was really quite, uh,
profound and also need for understanding, right, uh,
for people to really understand what is the role. Because now you have a test.
First of all, where did the test come from? What's, what is the, um,
you know, what is the entire life cycle of a test and meaning,
what does it take to bring a test up?
Because I remember early days March of 2020, uh, I was in Washington,
DC as part of the American Clinical Laboratory Association's board meeting.
I'm now the, actually the chair of that board. Um,
and we were called to the Pence White House to,
to meet with the Pence team on testing. And they, you know,
that was the day that Trump made the announcement that every American that
wanted to test or needed a test was gonna get a test and the test didn't exist.
So I think it just,
the whole idea of what does it take to build a test infrastructure?
What does a test mean for an individual? What kind of information do you need?
Because it's not just a test, but what does it mean for you?
All that stuff was really thrust into the, into the, into the limelight for a,
for a prolonged period of time. I mean, it was well over 12,
16 months that we're really talking about testing once some way,
shape or form as a major, a major news story globally.
Do, do you think it did anything for expectations? You know, I remember too,
you were talking about the early days of the pandemic and I,
I think there was some frustration depending on where you were in this varied
city to city, but wait times for test results. Uh,
do you think by better understanding the entire, you know,
test creation in individual testing like you mentioned,
do you think the public gained more information and understanding of
turnaround times or,
or do people continue to have like Uber eats DoorDash expectations for
immediate results like they do in most things right now?
Well, I certainly, I think that, um,
it created consternation for all of us that needed a test that they were so
inaccessible. And I, and I, I think it really,
it raised people's expectations about, um,
cuz we've been able to do home testing for a long time. It's been a relatively,
a very minor part of the overall testing, uh,
landscaping the United States and globally.
There's a real now and much more of an interest in this.
It's probably not at the height of where it was say in now omicron wave of
covid,
but still there's I think a societal expectation that there's gonna be more
accessibility to testing. Um, and,
and also there's been a massive investment in the infrastructure cuz a lot of it
was just that the inf the reimbursement of labs is such that it didn't really
drive a lot of, uh, excess in the supply chain on tests.
So now there's been a massive global investment in testing infrastructure.
That's part of the dialogue we have to have in healthcare going forward is what
are societal expectations around testing?
How do we use what we've invested in to get us ramped up to provide testing for,
for individuals and for patients, and how do we carry that forward? Uh,
I think that's really important and it, and it,
it is a societal question because, uh,
as much as we think about convenience and the inconvenience of having to wait
for a test,
we also know that outcomes in covid were directly could be directly linked to
access to testing, right? So, so areas and, and,
and populations that lower access to testing tend to have poor outcomes.
So we now really see this as part of the whole landscape of disparities as well
as access and convenience.
Dr. Maurice, let's talk a bit more about Mayo Clinic. You know,
you mentioned you've been there for about 35 years,
an exceptional place for healthcare, both on a national level,
international level.
Can you share some points of pride with me about Mayo's clinical or lab
capabilities? I,
I'm really talking to someone who heads up a lab at the best of the best in what
American healthcare can be and can do. I'm,
I'm curious if you have any stories that can encapsulate the possibility of what
can be achieved at Mayo Clinic.
Yeah, I'd love to. Obviously I've devoted my whole career to the place and, um,
and I've obviously, and Mayo has done so much to enrich my own personal life,
professionally and done so, I think does so much for,
for healthcare in this country and globally. Uh,
and I think it's important that institutions like Mayo Clinic really continue
to, to, to be a,
a voice in healthcare where healthcare is going specifically for diagnostics is
very interesting in that. Um, so we have 150 plus year history, right, uh, of,
of, of our institution, uh,
very unique founding here in in rural Minnesota and then spreading from there.
But if you look back,
diagnostics a and laboratory medicine were actually one of the, the earliest,
um, investments by the Mayo Brothers.
We think of the Mayo Brothers and surgeons,
but a lot of the very early innovations in diagnostics actually came out of Mayo
Clinic, whether it's intraoperative frozen section, which was, you know,
at the turn of the century or the first grading of tumors, uh, by Dr.
Broders in the 1920s. It just goes on and on. And so the question is, you know,
why, you know, why is that so important?
Why was that so important to the Mayo Brothers and to the,
to the early founders of Mayo Clinic? Um,
and it really goes back to our model of care is is and what I'm really proud of,
what's kept me here are values our Franciscan values,
but teamwork is one of those key ones.
And so the whole Mayo Vision was that you would have physicians and providers,
healthcare professionals that focused on the need of the patient that when a
patient came through the front door Mayo Clinic,
they had a team of people that were all their,
their primary job was working together, right?
To understand and what came to be very serious and complex illnesses that
couldn't get answered elsewhere, people were coming here.
Information for that is actually the data.
Any team functions best when there's clear understanding of the context i e the
data, right? And, and good communication of that. So I think this,
this whole investment of labs is really seeing labs cuz labs generate 70,
80% of the quantitative data in the medical record, right?
So the idea that diagnostics were so key for a team-based practice
of medicine and the first integrated medical practice to work,
that's the pride that I take in working at Mayo. And I, I tell people,
I don't know if I would've done pathology but would've been at Mayo Clinic
because we are as pathologists and laboratory in such an integral part of the
care teams, um,
what makes me really proud is the fifth year history of Mayo Clinic Labs because
that through that activity of the reference lab,
we've been able to open that team-based model of care outside of our campuses,
right?
Because patients can interact with the data and the providers and we can inform
the care of that patient without them being around our campus through Mayo
Clinic Laboratories. And so it, but it all,
it forms a very much a symbiotic relationship where interacting with patients on
the outside brings information into our institution that we can then learn from
and share more information. Um,
and so one real tangible example of that is we've had a long history of
neurologic, very strong neurology practice.
We see patients that come in many times after they've had other cancers or
neoplasms and they have disorders of their neurologic system that are very
difficult to understand and diagnose.
Well it turns out that your brain and your central nervous system expresses over
80% of the proteins in your body. So when you have something like a cancer,
you can start to get antibodies to those proteins or immune reaction to the
proteins or autoimmunity that can cause very specific and treatable,
but sometimes irreversible if not treated neurologic diseases.
And we now have a laboratory in Rochester that is staffed by
neurologist who are seeing these patients and identifying these new,
cuz there's so many, there's these new patterns of disease,
but then we can make available to the outside world. So, so it's really that,
that kind of ability to make the, the Mayo Clinic model more inclusive.
That that, that's part of my real pride in working at Mayo Clinic,
in lab medicine at Mayo Clinic Labs.
And even the story of the origins of lab at Mayo Clinic. You know,
you mentioned the Mayo Brothers are known predominantly for being surgeons,
but also one of their fo first focus areas was the lab.
That kind of goes back to your earlier remarks about how pathology sometimes
blends into the background.
It doesn't always receive the recognition that it should.
Yeah. And it's just because we interact with it and I think that's coming,
it goes back to the pandemic. Cuz most of the time when we think about the lab,
we think about going to the doctor, doctor orders a test, test comes back.
The interaction is very much with that, with that provider haven't been there.
But then you start to step back.
Covid forced us to take the macro view of testing.
What does testing do for healthcare? What does testing do for society?
How should testing be used going forward?
And also the focus on the need for innovation, right? Because everything,
whether it's covid and a new pathogen or what I just described,
it's also a real hotbed for innovation. So we have to really think about that.
Um, and last but not least in the,
we are in the era of now big data and we just think now about large language
models and everything else.
If you think to the fact that 70 to 80% of data coming into the health rate
comes out of the laboratories, even from a healthcare perspective, uh,
and healthcare delivery,
you still have to start thinking about that in a much different way.
Mm-hmm. . Mm-hmm. ,
I wanted to get a sense from you about how much of a concern over utilization
of, of diagnostics or lab testing is.
And I it seems as though there's so much, so,
so much in healthcare is scarce right now or in short supply and it's been that
way actually for, you know, for a number of years.
But the issue of over the utilization,
it doesn't seem like it gets the attention or the amount of conversation that it
once did. Dr. Maurice, I'm curious, what's your view on this?
How pressing of a problem is it, have we come, have we made any progress in,
in accounting for it through data like you may mention of,
or is it still something that is persistent?
Um, I think it's still a hill that we have yet to climb. And I think it's a,
it is a problem for, for my profession, for laboratory medicine.
It's a problem for healthcare. But if you think about laboratories, um,
that over utilization,
I think that some of the studies have suggested that 30% or more of tests are
overutilized you know, 30%, there's 30% excess in testing that's performed.
It really does a few things that are really bad for patients and bad for
healthcare. First of all, there's just the waste of the, of the testing itself.
Second of all, it really forces, it,
it drives you to think about something more as a commodity as opposed to an
asset, right? So if we're over utilizing tests, we think oh,
we can just do so many tests. We're now,
that's one of the things that precludes us from seeing the value in testing for
healthcare and for individuals. Um,
and then last but not least is that that data actually drives
more over utilization. So my passion and my, my background is,
and expertise is in the diagnosis of blood cancers and particularly difficult to
diagnose blood cancers, uh, a certain part of the immune system.
And most of the time I would see patients getting evaluated for these diseases.
Often it's because there've been overutilization of other tests that made the
doctor think, oh no, I gotta rule out this rare cancer, right?
As opposed to if we'd been more intentional about how we use the entirety of the
laboratory,
we can really focus those high power tools on the patients that really need it.
What we're seeing is if we don't do that now,
there's pushback from payers to actually pay for the test. So on the one hand,
especially going into Covid now coming out,
the promise was on individualized medicine or personalized medicine,
which really connotes a deep level of diagnostics around each person so you
really understand their disease. Those tend to be more expensive tests.
If there's not a strong rationale to a payer for why they're being performed,
they just see a more expensive test that's probably driving a more expensive
therapeutic.
So what it does ultimately is it actually decreases access to the more
specialized care cuz over utilization is forcing payers to think of things more
in bulk and just trying to drive out cost as opposed to creating value with the
laboratories.
That makes sense. Can you, just to make sure I understand you clear,
can you walk me through an example of the lab data,
the testing data actually driving more utilization?
I think you just did at a high level on how payers receive it,
but can you almost walk me through if,
if there were a specific case you could illustrate for me so I better understand
that, that thought?
Sure, sure. So a, a really good example would be in cancer care again, right?
And if you think now we are starting to migrate or,
or really progress our thinking in medicine to think of can most
organs we think of as organ-based cancers, right? There's lung cancer,
there's colon cancer, there's breast cancer.
To where now we're really understanding these as pathway diseases.
Meaning there's certain,
there's certain pathways by which cells grow and differentiate and know when to
stop growing that can get perturbed in different sites in the body.
And when they do, they can lead to cancer.
And so the drugs are more targeted at those pathways, right?
So we get much more specific treatment.
The way we detect those is with typically with expensive next generation
sequencing tests. And so those tests are much more,
when we think of tests as being a few hundred dollars, that's one thing.
When you think of tests being five, $6,000, it just gets a lot more attention.
What I think payers are seeing is they see, uh, uh,
an an increase in the use of these tests, right?
So they can see now their lab spend is going up,
it's going up on these more esoteric tests. Um,
and at the flip side is they can also see the specialty farmer going up,
but then they try and link them together in their databases.
They don't see any rationale. So they'll see a patient get a, you know,
a very expensive test, maybe get one or two cycles of a drug.
They can't actually match that.
The test results drove the prescription of the drugs. So now they just say,
well let's put in a lot of prior authorization just so it's not too many people
get this test cuz So it's the only tool that they have as opposed to let's work
with academic medical centers,
let's work with medicine to develop treatment guidelines so that we actually
think about the testing as part of that treatment guideline cuz then will then
drive the use of the therapeutics. So that's an example that's seeing thousands,
you know, of of,
of these tests being performed without any kind of care-based rationale for the
performance of the test and then driving expensive drugs. Hope,
hopefully that makes sense.
No, it does. Thank you. Thank you very much for the example. Um, yeah,
I'm curious about that. I think you, you raised some,
some really good stats there.
You know how it's still a hill we have to climb 30% or more of tests are
overutilized also.
I i I think it's a really interesting point you raised about how it can drive
one to think about testing as a commodity more so than an asset.
Is that something that you've seen as a long-term like cultural risk almost and
how diagnostics are,
are treated and thought of in a system?
Yes, it is a,
it's a risk for healthcare for patients and it lies on both ends of the
spectrum. Because on the flip side, there's often,
when we talk about over-utilization and you think about less expensive tests,
we know there's a lot of tests that are actually underutilized and particularly
in the management of chronic illnesses. And that kind of goes back to, um,
when you, the, to me,
if we start to think about diagnostics as a tool that can help us to bend the
cost curve in healthcare, which we have to do as to how do you use he,
how do use diagnostics across that continuum of care.
Cuz we probably are under utilizing at home or easily accessible tests to help
manage chronic diseases to make sure patients don't get into trouble like
diabetes or heart disease, right?
So we might have underutilization at that end of the spectrum and
overutilization at other ends.
So really thinking about what diagnostics can do holistically to drive value in
healthcare across the board from, you know,
intensive episodes of care around cancer to the management of chronic diseases,
I think is where we need to go.
And that's why being smart about how we use the test,
the purpose and the value that they're creating in each episode will be really
important. And, and there again, we had those conversations in Covid.
How can we make them persist when we talked about screening tests and their
value in helping protect people from the spread of disease and those things,
right? You have to think about, it's not just a test,
it's a question you're trying to answer and the setting that it's in,
that we all have to come together.
And so it really is very much a healthcare issue.
Mm-hmm. We've talked a bit about covid,
we've talked about about Mayo and its history.
We've talked about still some challenges that the system needs to confront.
Let's talk about what's new, what's a relatively new or emerging issue. Dr.
Marie said it's been commanding a significant amount of your attention as of
late. Uh,
I would love to learn more about it and also why you find it so compelling or
concerning in this moment.
Um, it really twofold. I'll talk about the, the,
the medical side first and then sort of the, the, the,
the policy side second. Um, so I think on, on the medical side,
it's an extraordinarily exciting time and I think I, I have the benefit of,
again, growing up and being, I I tell people I'm home ized .
I mean I've only been in Mayo, so, but to be,
it's a very boundaryless if you think about it,
it's a whole ethos of our institutions around teamwork and then we tend to be
boundaryless in our areas of care. So I don't think about a machine,
I think about the lab and I think about radiology and I think about the patient
and I we're entering an era where all this data can start to flow together.
Uh, digital pathology is sort of the last, will be one of the last strongholds,
if you will, of the old way of practicing, like practicing laboratory medicine.
Once we get to where the actual histology is digitized and we can see continued
evolution of things like chat, G p t and large language models,
you can start to imagine where having all this information can come together
much more rapidly and seamlessly for a patient. So the,
so the lab rather being as symptomatic of fragmentation and care is actually a
solution. We think about tools that sit on top of diagnostics,
whether they're radiology or labs that actually create a much more seamless
experience for a patient and let them know where they need to go, access care,
what level, et cetera, et cetera. To me that's a,
that's a super exciting time cuz that's what I've always thought about is that
the,
the whole purpose of this is to get as much information around that patient and
the provider, the physician to really create meaning for them.
And so this is a time we could actually achieve that in,
in ways that we never could before. Um,
so that's my passion is driving towards that and again,
thinking about everything from at-home testing to the really esoteric stuff that
we do at Mayo Clinic. In that equation,
the concern that I have really is around, uh, around policy. Uh, particularly,
uh, you know, in my role at the American Clinical Laboratory Association,
we still have the protecting access to Medicare Act, which is, you know,
if there's not another delay, we'll see a drop in reimbursement. Uh,
for many of the, of the, of the more commonly ordered tests,
labs are already financially strapped.
Laboratories are one of the three pillars along with surgical procedures and
radiology that support a lot of hospitals. So it could be destabilizing there.
So on the one side we see this promise,
but then you see the risk of particularly reimbursement being dropped because
again, we're not thinking about the value of the labs, but rather just the cost.
And the cost is such a small fraction of overall healthcare.
And then there's regulatory things as well. How do we continue to work with, uh,
you know,
to work with other stakeholders so they can feel like we're safely innovating.
The labs need to be, they're,
they're really at this intersection between the practice,
the medicine and science and technology.
So we need to really be thoughtful about regulatory practices that might govern
that.
Zooming in on the policy side first, and then I'll share a thought with the,
the medical side that you just described, Dr. Maurice,
but you had mentioned the payers are being a bit more rigorous and challenging
or prior offing the daylights out of those specialized expensive
tests that can be ordered.
And what you just described here is a drop in reimbursement for commonly ordered
tests.
So it seems like both the extraordinary and the ordinary are going through their
own sets of reimbursement struggles.
Yeah, they are. It's a bit of a silly crib, if you will. Um, they're the, uh,
you'd at both ends. Um, but it does,
it's just a real need to understand not just the role of
laboratories in healthcare,
but also to have a mind towards how that translates into the economics of
healthcare and the sustainability of healthcare. So we can have more informed,
either create for payers the tools that they need, that they, cause look,
payers don't really,
they use the private payers use things like prior auth because they just don't
have very many uh, um,
mechanisms or levers they can pull to control some of these things.
So we have to understand that context and, and really focus on that. And,
and same on on the, like I,
like we talked about how do we start to create their payer databases.
There's lots of places where you can go and create the financial models that
demonstrate the economics of the,
of the situation that will actually get to more to reimbursement policies
that will actually drive healthcare behaviors in the direction that we wanna go.
And a less frictionless way for patients.
Cause it's really patients that get stuck in the middle. But that's,
we have to really view it in that way.
That's why I'm excited in my role now as the president and CEO of Mayo Clinic
Labs, that's my focus now is thinking about that,
that taking my 35 years of experience if we count medical school and trying to
pivot that now to think about these issues. Mm-hmm.
. And then the other part you mentioned about the digital pathology
kind of last frontier in so many ways as you just described,
for patients especially.
But what struck me as you were talking about that where all that data lives
together is how much more upstream opportunity there can be for, for patients,
for care teams to have all that information stored in one place to be able to
build upon it. It, it seems like so much of healthcare,
there's so many problems downstream that seems like such a great and bright
opportunity further upstream that could really be seized and a lot of value
derived from.
I I couldn't agree more. And I think that's, look,
I I I love that I've been at Mayo for my career. Uh,
my wife loves it cuz she's from Minnesota, so we've raised our family here. Uh,
but uh,
but the reality is that we need to think about ways that that knowledge and that
places like Mayo and others, there's been many great healthcare institutions.
How do we make that more scalable for patients, right?
Mayo Clinic Laboratories and getting the testing out there was,
was a first step in that.
As we think more upstream and about how this data is coming together and created
the digital technologies like Drer's vision around Mayo Clinic platform for
Mayo. Those are the things that start to make that knowledgeable, scalable.
Because if we're not thinking about access,
if we're thinking about just building ivory towers,
then we're not doing what we should be doing for healthcare. So, so I,
I think that's the excitement for me is to think upstream cuz that's where that
scalability of knowledge and knowledge exchange comes from.
Well, Dr. Maurice, we've touched on so much in this interview, but you know,
one thing we haven't talked about is,
is your role and your professional journey.
And like I had mentioned the introduction, you,
you hold the number of roles at Mayo.
I'm curious if you have any advice for colleagues listening who may like you
transcend boundaries of specialist, researcher, executive,
what is most important as you find yourself thriving in each of these related
but distinct roles with Mayo Clinic?
God, um, it's, uh,
I think the one thing is that follow your curiosity. Continue to learn,
continue to be open. I mean, everyone, I think my,
where I am in my career is that I'm just been blessed to be around a lot of
really smart people that have taught me lots of different things. And, and so,
and then you just continue to accumulate different sorts of perspectives that
become valuable to you and hopefully valuable to others as you go through your
career. Um, so, and, and, uh,
and the other thing is to really identify your passions and, and go with them.
You know, it's, it's, uh,
I've always been a very inquisitive person just because, you know,
you were born when I was starting medical school doesn't need id to stop being
inquisitive at this point, right? So I think those are, those are the things.
But, um, surrounding yourself with good people, being curious, being humble, uh,
hopefully I, I I embody some of those things.
I think those are the real keys to me.
Yeah.
Is there anything we didn't touch on in our time together that you'd like to
make mention of?
God? Well, we talked about a lot, so, um, I don't know. I think we,
I think we touched on the, on the, on the high points for sure. Great.
Now we might get transcendent to the areas I shouldn't talk about on the
podcast.
Like the fact that I actually sing in public every year at Christmas for my,
for the town halls, which stuff like that, which probably I shouldn't do,
but .
Well that's even all the more impressive given you are, you know,
a lifelong red Rochester. I, I don't know if you live there, Dr. Maurice,
but she nonetheless worked there for 35 years and sing every year. Um,
you can't be that bad. So, , um, I, I wanna thank you for your time.
I learned a lot from you today.
Thanks for sharing your thoughts with our listeners and helping us see and
remember the value of labs specifically. I,
I wanna wish you continued to lock in your, in your role with Mayo.
Well, thank you very much and again, really a pleasure. Uh,
thanks for having me on and I, I've really enjoyed it.